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Patologi Manusia Dasar

GANGGUAN SALURAN
CERNA BAGIAN ATAS
Iskandar, dr.

Saluran Cerna Bagian Atas


(Upper GI Tract)

Dari mulutorofaringlaringofaringesofagus-gasterduodenum
Batas Saluran
Cerna Atas-Bawah:
Lig. Treitz (pada
flexura
duodenojejunalis)

Oral Cavity

Caries
Gingivitis
Periodontitis
Aphthous ulcers
Oral herpes
Candidiasis
Leukoplakia
metaplasia
cells produce keratin
associated with tobacco

use

Squamous cell
carcinoma

Oral Inflammations and


Infections

Gingivitis
Oral candidiasis (thrush)
Herpes Simplex (cold sore)
Parotitis
Stomatitis (inflammation of the mouth)

Gingivitis
Etiology Neglected oral hygiene
Stress

Manifestations

Bleeding during tooth brushing


Pus
Loosening of teeth (peridonitis)
Treatment
Prevention, Dental care, dental rinses,
flossing

Oral Candidiasis (Thrush)

Etiology Candidiasis albicans


Immunosuppression

Manifestations
White patches in oral cavities
Treatment
Nystatin swish and swallow
Amphotericin B

Herpes Simplex (Cold Sore)

Etiology Herpes simplex I or II


Stress exacerbates

Manifestations
Vesicle formation
Treatment-antivirals
Zovirax

Parotitis

Etiology Staph, Strep,virus

Manifestations
Pain in gland/ear
Lack of saliva
Treatment
Antibiotics, analgetic
Mouthwashes

Stomatitis
(Inflammation of the Mouth)

Etiology-

Side effect of chemotherapy


Trauma
pathogens

Manifestations

Excessive salivation
Halitosis
Sore mouth
Treatment

Remove cause
Soothing mouth wash solutions
Blend diet

Oral Cancer

Common sites

Lower lip
Lateral border of tongue
Buccal mucosa
Etiology
Tobacco use
Chronic irritation
UV light-Cancer of the lip

Manifestations of Oral
Cancer

LeukoplakiaSmokers patch
Erythroplakia
Sore that does not heal
Late

Pain especially moving jaw


Dysphagia
Cancer of the lip-induration
Pain in tongue when eating

Normal
Esophagu
s

Diseases of the Esophagus

Can present
with
dysphagia
pain
bleeding

Achalasia
spasm of the

lower
esophageal
sphincter

Hiatal hernia
protrusion of

stomach through
esophageal
hiatus

Achalasia

Incomplete relaxation of LES (resting


pressure >30mm Hg)
etiology
idiopathic - most common
Chagas disease - Latin America
secondary to cancer (esophagus, stomach)

Hiatal Hernia

2007 Thomson - Wadsworth

Barretts Esophagus

I.

Barretts esophagus ulceration of posterolateral wall

II.

Midesophageal stricture from healed Barretts ulcer

III.

Adenocarcinoma secondary to Barretts esophagus

Esophagitis

GERD (#1 cause)


Infectious esophagitis
Pill esophagitis
Caustic ingestion
Radiation
Sclerotherapy

Infectious esophagitis
clinical manifestations

+++ Odynophagia
Dysphagia
Solids & liquids

Fever (uncommon)
Bleeding (uncommon)

Esophagitis - diagnosis

Endoscopy
Infectious
Candida white plaques
Herpes vesicles
Definitive dx via biopsy

Candidal esophagitis
Common in
HIV
Antibiotics
Chemotherapy
+++dysphagia
Tx: fluconazole

HSV Esophagitis
Common in:
Chemotherapy
HIV
Tx: acyclovir

Esophageal Strictures
I.

Caustic stricture

Narrowing of 2/3 of esophagus due to


caustic ingestion years ago

Accidental in children

Suicide

II.

Radiation stricture

Smooth midesophageal stricture

Esophageal Carcinoma

Arise from
squamous
carcinoma
Risk factors
are
tobacco use
alcohol abuse

Tends to
invade &
metastasize
early

Acute Hemorrhagic Gastritis

Uncommon
Caused by
aspirin &

NSAIDs
alcohol abuse
heavy smoking

Upper
abdominal
pain, nausea,
vomiting

Stress Ulcers

Superficial defects
Associated with
stressful
conditions
trauma
brain injury
alcohol abuse

Called erosions

Peptic Ulcer Disease

Erosion
superficial to muscularis mucosa
no scarring

Ulcer
penetrates muscularis mucosa
scarring

PUD - etiology
Duodenal

Gastric

H. pylori

90%

60%

NSAIDs

7%

35%

Stress-induced

<3%

<5%

Zollinger-Ellison

<1%

<1%

PUD Hx and Px

Abdominal pain (94%)


Generally epigastric
Usually worst 2-4 hours after meal
Often between 2-3AM (HCl secretion

highest)
Relieved with antacids

Duodenal ulcer
Pain worst before meal
Relieved by meal

Peptic Ulcers

Deep, solitary defects


Mostly caused by H.
pylori
About 80% occur in
duodenum & 20% in
stomach
Associated with chronic
gastritis, cigarette
smoking, & long-term
use of NSAIDs, alcohol
Can be affected by
stress
personality
family history

Zollinger-Ellison Syndrome

Pancreatic islet tumor which secretes


gastrin
This leads to recurrent ulcers

Gastric Carcinoma

95% are
adenocarcinomas
Worldwide as deadly
as lung cancer
Risk factors
H. pylori & chronic

atrophic gastritis
diet high in smoked,
pickled, or saltpreserved food
diet low in fresh fruit &
vegetables

Usually asymptomatic
until advanced

Congenital Anomalies
Gastroschisis

Omphalocel
e

Umbilical
Hernia

Vascular Diseases

Ischemia due to

atherosclerosis
embolism
vasculitis
volvulus
shock
CHF
MI

Diarrheal Diseases

May experience
dehydration
Irritable bowel
syndrome

functional
abdominal pain, bloating

Viral & bacterial


enterocolitis

either upset of normal

flora or introduction of
pathogen
rotavirus
Norwalk virus

Protozoal infections
amebic dysentery
giardiasis

Inflammatory Bowel
Disease
Episodic
bloody diarrhea
Autoimmune etiology
Genetic influence
Involvement of extraintestinal tissues

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